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April/May 2022 Billing and Coding Article Updates

Billing and Coding Articles

Billing and Coding: Complex Drug Administration Coding (A58620)

J0248 remdesivir (Veklury®) was added under Infusions Non-Chemotherapy Generic/Trade Names table and to CPT/HCPCS Codes Group 2 Codes effective 04/21/2022.

Billing and Coding: Denosumab (Prolia™, Xgeva™) (A52399)

The following statement has been further clarified to add (calcium 1000 mg daily and at least 400 IU vitamin D daily): Patient adequately supplemented with calcium and vitamin D (calcium 1000 mg daily and at least 400 IU vitamin D daily).

Billing and Coding: Ranibizumab, Aflibercept, Brolucizumab-dbll and Faricimab-svoa (A52451)

HCPCS code Q5124 has been added to the CPT/HCPCS code section. The first sentence in the “Coding Information” section has been revised to add ranibizumab-nuna and faricimab-svoa: The administration for ranibizumab, ranibizumab-nuna, aflibercept, brolucizumab-dbll or faricimab-svoa must be billed on the same claim as the drug, with CPT code 67028 (intravitreal injection of a pharmacologic agent). The following statements have been added under the heading “For claims submitted to the Part A and Part B MAC:” Ranibizumab-nuna should be reported with HCPCS code Q5124; and Faricimab-svoa should be reported with HCPCS code J3590.

Billing and Coding: Molecular Pathology Procedures (A56199)

Added ICD-10-CM diagnosis code C56.3 to the "ICD-10-CM Codes that Support Medical Necessity" section- Group1, effective for services rendered on or after 5/1/2022.

Sterilization (A59060)

Under the Medicare Program guidelines the coverage of sterilization is limited to necessary treatment of an illness or injury.

Sterilization means any medical procedure, treatment or operation for the sole purpose of rendering an individual permanently incapable of reproducing that is not related to the repair of a damaged/dysfunctional body part.

Posted 4/26/2022